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Organization

NORTHSIDE IMAGING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JORGE J HERNANDEZ (VP-ADMIN, CCO)
(404) 851-6378
Entity
Organization

Contact information

Practice address
638 441 HISTORIC HWY N, SUITE D, DEMOREST, GA 30535-4574
(706) 454-9900
Mailing address
1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary

Other

Enumeration date
05/24/2016
Last updated
05/24/2016
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